Endodontic System Research Articles

Effectiveness of mechanical vs. chemomechanical methods in removing intracanal calcium hydroxide medication: a randomised trial.

To compare the mechanical and chemomechanical methods for removing calcium hydroxide medication from the root canal system. The triple-blind, randomised clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from December 16, 2022, to June 15, 2023, and comprised patients having necrotic teeth and chronic apical pathosis. They were randomised into groups A and B. On the initial visit, after access opening and chemomechanical preparation, calcium hydroxide paste was placed as an intracanal medication in both groups. the patients were recalled after two weeks. In Group A, calcium hydroxide was removed from the canals using a rotary master apical file, while in Group B, an endoactivator was used to sonically agitate the endodontic irrigant. Verification of placement was done by using a periapical radiograph. Data was analysed using SPSS 26. Of the 98 individuals assessed initially, 60(61.22%) were included; 34(57%) females and 26(43%) males with age ranging from 19 to 57 years. There were 27(45%) incisors, 22(36.7%) premolars and 11(18.3%) canines. There were 30(50%) patients in each of the 2 groups. The intergroup difference was not statistically significant (p=0.43). Tooth arch did not significantly correlate with the removal method (p=0.79). Both methods were found to be equally effective in removing water-based calcium hydroxide medication from the endodontic system. NCT05744661.

Evidence of an effect of statins on lesions originating from dental infection. A retrospective clinical investigation

BackgroundApical periodontitis (AP) is an inflammatory dental disease caused by bacterial infections of the endodontic system. The correlation between AP and cardiovascular diseases. (CVD) has been consistently investigated. Statins are a class of drugs that are used to treat hypercholesterolemia and prevent atherosclerotic vascular diseases. They have other beneficial pleiotropic effects such as anti-inflammatory, antithrombotic, and antioxidant activities. The aim of this study was to evaluate the oral health status and prevalence of AP in patients treated with statins (Group S) in comparison with untreated patients (Group C) to understand whether the anti-inflammatory action of these drugs can influence the prevalence of AP. MethodsThe records of seventy-nine patients (43 men and 36 women, mean age 68 ± 11 years, 1716 teeth) treated with statins and referred to the University clinic for dental evaluation were reviewed. Seventy patients free from systemic diseases and without therapy (39 men and 31 women, mean age 62 ± 9 years, 1720 teeth) constituted the control group. All subjects underwent complete oral, dental, and radiographic examinations to determine the presence and severity of AP. Periapical index (PAI) and decayed, missed, and filled teeth (DMFT) scores were obtained. ResultsAP was significantly less common in Group S (22,8%) than in Group C (50%) (P < 0.05). Furthermore, the mean value of the qualitative rank of the severity of AP (PAI score) was higher in Group C than in Group S (P ≤ 0.05). ConclusionsOur results suggest that statins can attenuate the prevalence of AP, which is associated to CVD.

Assessment of 2'-Fucosyllactose and Lacto-N-Neotetraose Solution as an Irrigant in E. faecalis-Infected Root Canals: An In Vitro Study.

Given the lack of an ideal endodontic irrigant on the market, this study evaluates the antimicrobial potential of a formulated solution of 2'-fucosyllactose and lacto-N-neotetraose against E. faecalis within infected root canals, and explores any associated impacts related to the duration of irrigation. 32 single-rooted teeth extracted for periodontal reasons were infected with Enterococcus faecalis, and subsequently subjected to endodontic treatment with two different irrigation systems: sodium hypochlorite or a solution of 2'-fucosyllactose and lacto-N-neotetraose. These samples were then incubated in sterile culture media at 37 °C to observe microbial activity through turbidity. The culture broth of each individual sample was assessed as positive or negative by observing the turbidity or lack of turbidity in the culture at the time of evaluation. the analysis of the results obtained from the comparison of groups irrigated with sodium hypochlorite or a solution of 2'-fucosyllactose and lacto-N-neotetraose demonstrates that the case solution has no bactericidal effect against E. faecalis inoculated in the endodontic system. the HMOs used in this study do not have a bactericidal effect on E. faecalis inoculated in an endodontic system.

Optimization of difficult endodontic treatment with nickel-titanium files in martensitic and austenitic phase

INTRODUCTION. Nickel-titanium alloys and cutting-edge design of endodontic files continue to revolutionize. In addition to variations in the design of nickel-titanium files, manufacturers have implemented several proprietary manufacturing processing procedures to improve their mechanical properties.AIM. The aim of the study was to improve the quality of mechanical instrumentation of highly curved root canals based on the data of laboratory and experimental analysis of rotary endodontic instruments made of nickel-titanium alloys of various modifications.MATERIAL AND METHODS. As part of the research, the following endodontic rotary files systems were studied during instrumentation of curved root canals: group 1 – Mtwo (VDW); group 2 – Race Evo (FKG), group 3 – Ultrataper next (Eurofile). A metallographic analysis of the instruments was performed, a morphological structure of the root dentin after instrumental was examined by scanning electron microscopy, as well as the amount of extruded debris was studied.RESULTS. Groups 2 and 3 showed significant deterioration after three applications. Mtwo files showed a statistically higher amount of surface damage after five uses (p &lt; 0.05). The smallest amount of extruded debris was found in the group 2, while the largest number of root dentin irregulations was found in the groups 1 and 3 (p &lt; 0.001).CONCLUSIONS. A different degree of the surface damage of the instruments was revealed, depending on the number of treated root canals. The safest and most effective endodontic system for the mechanical preparation of curved root canals is the Race EVO.

Morphological study of pulp cavity anatomy of canine teeth in domestic cats using micro-computed tomography.

An understanding of the pulp cavity anatomy of individual teeth is essential for success during endodontic therapy. The objective of this study was to document pulp cavity anatomy and summarize numerical data of maxillary and mandibular canine teeth of domestic cats using micro-computed tomography (micro-CT). Thirty-nine canine teeth from eleven domestic cat cadaveric specimens were extracted and prepared for scanning. Segmentation of the pulp cavity was performed using the Avizo (v2022.2) software package. The morphological features of the pulp cavity including overall shape, configuration, presence of apical deltas and lateral canals was recorded. A quantitative analysis was performed on thirty-one teeth to explore associations between pulp cavity volume and length, apical delta length, maximum apical delta foramina number and cusp-to-tip length using a linear mixed model. Correlation between pertinent continuous variables was assessed using a Pearson's correlation test. Most pulp cavities exhibited varying curvature and ranged from a cylindrical configuration in the coronal third to an ovoid configuration in the middle to apical third. A ribbon-like flattened canal was observed in 6/31 teeth (19%). All canine teeth depicted an apical delta with various configurations except for two teeth that showed a single canal exiting at the apex. In 15/31 teeth (48%), the primary root canal within the apical delta could be clearly identified and in 16/31 (52%) the primary root canal was indiscernible. The results showed that the pulp cavities of maxillary canine teeth were significantly larger and longer and the cusp-to-tip length was longer, when compared to mandibular teeth. The apical delta length was negatively correlated to the volume of the pulp cavity. No specimens depicted lateral canals. This study revealed that the anatomy of the canine tooth pulp cavity in cats can vary considerably and should be a consideration when performing thorough debridement, shaping and obturation of the endodontic system.

Complexity and Variability of the Endodontic System - Evolution of Root Canal Morphology Classification Systems

Complexity and Variability of the Endodontic System - Evolution of Root Canal Morphology Classification Systems

Upper First and Second Molar Pulp Chamber Endodontic Anatomy Evaluation According to a Recent Classification: A Cone Beam Computed Tomography Study.

(1) The possibility of knowing information about the anatomy in advance, in particular the arrangement of the endodontic system, is crucial for successful treatment and for avoiding complications during endodontic therapy; the aim was to find a correlation between a minimally invasive and less stressful endodontic access on Ni-Ti rotary instruments, but which allows correct vision and identification of anatomical reference points, simplifying the typologies based on the shape of the pulp chamber in coronal three-dimensional exam views. (2) Based on the inclusion criteria, 104 maxillary molars (52 maxillary first molars and 52 maxillary second molars) were included in the study after 26 Cone Beam Computed Tomography (CBCT) acquisitions (from 15 males and 11 females). And linear measurements were taken with the CBCT-dedicated software for subsequent analysis. (3) The results of the present study show data similar to those already published about this topic. Pawar and Singh's simplified classification actually seems to offer a schematic way of classification that includes almost all of the cases that have been analyzed. (4) The use of a diagnostic examination with a wide Field of View (FOV) and low radiation dose represents an exam capable of obtaining a lot of clinical information for endodontic treatment. Nevertheless, the endodontic anatomy of the upper second molar represents a major challenge for the clinician due to its complexity both in canal shape and in ramification.

Decontamination of the Endodontic System, in Terms of Minimally Invasive Approach

Decontamination of the Endodontic System, in Terms of Minimally Invasive Approach

Instrumentation time and effectiveness of hand and rotary files in a prototyped second mandibular primary molar: A micro-CT study.

Eccentric instruments have been proposed as more effective and less time-consuming for endodontic instrumentation. To compare biomechanical outcomes of different instrumentation systems and time undertaken for instrumentation in resin prototypes. Sixty standardized prototypes of mandibular second primary molars were instrumented according to the following systems: K-files, ProTaper Next (PTN), XP-endo Shaper (XPS), XP-endo Finisher (XPF), XP-Clean (XPC), and Sequence Baby File (SBF; n = 10/each). Irrigation was performed with saline with simultaneous aspiration, and time spent was recorded. The prototypes were micro-CT-scanned before and after the instrumentation, and image sets were reconstructed and registered. Non-instrumented areas, accumulated debris, removed root material volume, and canal transportation were quantified. Data were analyzed through ANOVA, the Kruskal-Wallis test, and the Wilcoxon signed-rank test (α = 5%). K-files and SBF resulted in more instrumentation time (p < .05). SBF, XPC and PTN removed less root dentine (p < .05), but PTN left more untouched areas (p < .05). Accumulated debris were lower for XPC and SBF (p < .05). Canal transportation was similar among the groups. Rotary systems reduced instrumentation time, whereas SBF and XPC resulted in more conservative instrumentation, with less debris accumulation and non-instrumented areas. A dedicated paediatric endodontic system (SBF) outperformed eccentric instruments in terms of effectiveness.

Evaluation of 3D-Printed Dog Teeth for Pre-clinical Training of Endodontic Therapy in Veterinary Dentistry.

Artificial teeth in dental training have become a valuable tool for students to gain hands-on experience in a safe and controlled environment. This training method allows students to practice various dental procedures and develop their skills without putting patients at risk. Artificial teeth can be used to simulate dental conditions, allowing students to gain experience in dealing with various situations and techniques. Although previous studies in human dentistry have demonstrated the feasibility of using 3D-printed teeth for teaching endodontic procedures such as root canal therapy, similar research has yet to be conducted in the veterinary field. This study aimed to assess the feasibility of creating 3D-printed teeth from an adult dog skull and validate their use as an alternative training tool for root canal therapy in this species. For this, cone beam computed tomography images from a medium-sized dog skull were used to replicate its teeth using a digital 3D printing system. Then, artificial mandibular first molar teeth and a 24-question survey were sent to specialized veterinary dentistry practitioners in Brazil to assess their perception of the model's characteristics during endodontic treatment. In conclusion, it was feasible to create 3D-printed models of dog teeth with high accuracy for the endodontic system. Despite the differences in the properties of the two materials between natural and artificial teeth, it was possible to use the artificial tooth as a training device for conventional endodontic treatment in dogs. The reliability level for the survey was reported as good, displaying a reliability coefficient above 0.86.

Modern Methods of Decontamination of the Endodontic System

Modern Methods of Decontamination of the Endodontic System

Analysis of Temperatures Generated during Conventional Laser Irradiation of Root Canals-A Finite Element Study.

The success of endodontic treatment is dependent on the removal of bacteria. A modern strategy to reduce bacterial load is laser irradiation. During this procedure, there is a local increase in temperature with possible side effects. The aim of this study was to determine the thermal behavior of a maxillary first molar when performing the conventional irradiation technique using a diode laser. For this study, a 3D virtual model of a maxillary first molar was created. The preparation of the access cavity, the rotary instrumentation of the palatal root canal and the laser irradiation protocol were simulated. The model was exported in a finite element analysis program where the temperature and heat flux were studied. Temperature and heat flux maps were obtained, and the temperature increase on the internal wall of the root canal was analyzed. The maximum temperature value exceeded 400 °C and was maintained for less than 0.5 s. The obtained temperature maps support the bactericidal effect of diode laser and the limitation of damage to surrounding tissues. On internal root walls, the temperature reached several hundred degrees Celsius, but for very short durations. Conventional laser irradiation is an adjuvant method of decontamination of the endodontic system.

Comparative Evaluation of Instrumentation Time and Quality of Obturation amongst Pediatric Rotary Endodontic System: An In Vivo Study.

This study assesses the instrumentation time and quality of obturation of three pediatric rotary endodontic systems-GT nickel-titanium (NiTi) (Prime Pedo), controlled memory (CM) NiTi (Pro-AF-Baby Gold) and NiTi-titanium oxide (NiTi-TiO) (Kedo SG Blue). A total of 60 children aged 4-8 were chosen at random for the study based on inclusion criteria that required pulpectomy in any of the primary molars and were separated into three groups of 20 samples, each based on the file system employed. The instrumentation time during the preparation of the canal is recorded using a stopwatch. An expert dentist was blinded to the instrumentation type and showed the periapical radiograph, which he or she graded depending on the quality of the obturation by categorizing it as underfill, optimal fill, or overfill. The observations were then recorded, tabulated, and statistically analyzed for the results. The least amount of instrumentation time was needed for NiTi-TiO (group III) files, followed by NiTi-CM (group II) and NiTi-GT (group I). NiTi-TiO (group III) has the most optimally filled and least underfilled obturations among the three rotary endodontic systems mentioned. Also, NiTi-TiO (group III) and NiTi-CM (group II) have the least similar overfilled obturations when compared with NiTi-GT (Group I). We conclude that NiTi-TiO needed the least amount of instrumentation time and generated the maximum optimally filled obturations based on our observations. Pediatric rotary endodontic systems are more convenient to use and reduce chairside time; thus, their use in children with behavior control issues might be more suitable. Kohli A, Chhabra J, Sharma K, et al. Comparative Evaluation of Instrumentation Time and Quality of Obturation amongst Pediatric Rotary Endodontic System: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):338-343.

One endodontic system with two movements.

One endodontic system with two movements.

The Effectiveness of Laser Assisted Irrigation in Endocanalary Disinfection and Hard Tissue Debris Removal: A Systematic Review

Introduction: The control of the bacterial load during an endodontic treatment is challenging; the usual chemomechanical procedures such as conventional needle irrigation (CNI) has not always shown satisfying outcomes. Hence, the necessity of finding complementary methods such as passive ultra-sonic irrigation (PUI), sonic activated irrigation (SAI) and laser assisted irrigation (LAI) in order to achieve the most complete disinfection of the endodontic system. The aim of our study is to systematically review and critically analyze the current evidence of the effectiveness of laser assisted irrigation when compared to CNI, PUI, SAI. Materials and methods: Electronic search on four data-bases: PubMed, Scopus, ScienceDirect and Cochrane Library was done looking for Systematic reviews, in-vitro and clinical controlled trials assessing the effectiveness of LAI in removing bacteria and dentine debris. Articles were selected, deduplicated than assessed. The studies that met all the inclusion criteria were included and were further screened in order to extract their data and evaluate their methodological quality. Results: The electronic search yielded a total of 895 potentially eligible record. After the final stage of selection, 25 studies, that are all in-vitro were included; the risk of bias and quality assessment was done through the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Joanna Briggs Institute critical appraisal Checklist. All in all, LAI showed better results when compared to CNI in both removal of bacteria and smear layer, yet when compared to PUI and SAI, the studies could not testify significantly for the superiority of an activation method over another. Conclusion: The use of LAI increased the potential of the irrigant within the endodontic system, especially when compared to CNI. Yet the current data could not give a conclusive judgment of the effectiveness of LAI when compared to PUI and to SAI; eventually further studies need to be performed.

Effect of Laser Irradiation on the Apical Root Canal Sealing

Cleaning and shaping of the root canal system are essential for the successful outcome of endodontic treatment. In addition to the routinely used irrigating solutions, other technologies have been investigated for the treatment of root canal dentine, such as different types of laser systems. Purpose: The aim of our in vitro study was to evaluate the effect of different types of laser irradiation (Er:YAG , Nd:YAG, diode laser and photodynamic therapy) on the intracanal dentin and their interference in the apical seal of filled root canals. Methodology: 72 human single rooted teeth were randomly assigned into 6 groups. Root canal preparation was done using ProTaper Universal rotary system up to F3. The laser irradiation was performed at the end of the traditional endodontic preparation as a final means of decontaminating the endodontic system. Teeth were filled with a core-carrier system Guttacore (Dentsply, Sirona) and sealer AH- plus. Results: Statistical analysis showed that all groups had significantly less leakage in apical third than the control group. The laser-treated groups presented better results than Group II (Classical disinfection protocol), without statistically significant difference. The morphological changes on the apical intraradicular dentin surface caused by Nd:YAG and Er:YAG laser irradiation resulted at least linear dye apical leakage. Conclusions: Laser irradiation may improve the apical seal of the root canal. Different type of laser systems with appropriate parameters are recommended to be used as an adjunct to the current chemical root canal disinfection protocols.

NEGOTIATING THE CURVES WITH AF-F ONE FANTA ROTARY FILE: A CASE REPORT

The Posterior teeth often present with curved and dilacerated roots, a significant challenge for the clinicians during the endodontic treatments. The efficient biomechanical preparation is also affected by improper instrumentation in the curved or constricted canals. The use of conventional instruments and techniques in the dilacerated roots may develop ledges, fractured instruments, and canal blockages which further complicate the endodontic treatments. The introduction of Fanta AF-F One rotary file instruments has significantly impacted the biomechanical preparation of root canals systems. The Fanta AF-F One rotary file has noted advantages such as increased flexibility, higher strength, and wear resistance over the conventional rotary endodontic systems. The present case series discusses the endodontic treatment of two severely curved root canal systems successfully treated with Fanta AF-F One rotary file endodontic system.

Platelet-Rich Fibrin: A Viable Therapy for Endodontic-Periodontal Lesions? A Preliminary Assessment

Background and Objectives: The endodontic system and the periodontium are closely interrelated and the infection of both leads to the appearance of endodontic-periodontal lesions. Along with the endodontic and periodontal classic treatment, in most cases, there is a need for regenerative periodontal therapy for the repair of the damaged tissue. One material that stimulates bone healing is represented by platelet-rich fibrin (PRF). The aim of this study was to determine if the inclusion of PRF in the treatment protocol of endodontic-periodontal lesions is effective. Materials and Methods: This review was conducted according to the PRISMA guidelines. Four databases, MEDLINE (through PubMed), Scopus, Web of Science, and Google Scholar, were used in order to find all significant articles on the topic. Relevant keywords were used in different combinations. Results: The inclusion criteria were met by six studies, published between 2014 and 2020 and they were selected for the review. The use of PRF for the regenerative therapy of endodontic-periodontal lesions showed favorable outcomes in all of the studies included, with significant reductions in the probing depths. Conclusion: While platelet-rich fibrin may be beneficial, further research is needed.

A computed tomographic study of endodontic and apical changes in 81 equine cheek teeth with sagittal fractures.

Sagittal fractures of equine cheek teeth are commonly observed during oral examination. There are few reports on the apical and endodontic pathology associated with such fractures seen during computed tomographic (CT) examination. This study aimed to document the prevalence of CT changes indicative of apical disease in equine cheek teeth, which have suffered a sagittal fracture involving the clinical±reserve crown. This study is a retrospective case series. CT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed: 81 teeth from 49 horses were identified to have a sagittal cheek tooth fracture. The images were evaluated for apical pathology including gas (in the endodontic system and periapically), widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling. An apical infection grading system was created to give each tooth a score. Hounsfield units were used to measure the density of the endodontic, apical and periapical regions. The fracture length ratio was recorded. Statistical analysis was performed using a generalised estimating equation to evaluate predictors of apical infection and associations between clinical signs and CT abnormalities. Eighty-seven sagittal fractures (56 buccal, 17 palatal/lingual and 14 midline) from 81 teeth were recorded (74 maxillary and 7 mandibular). Apical infection was diagnosed in 73% (37/51, P=.05) of buccal, 55% (6/11, P=.07) of palatal/lingual, 100% (13/13) of midline, 100% (6/6) of multiple fractures and 96% (23/24, P=.008) of fractures involving infundibula. There was no significant relationship between apical infection and the presence of clinical signs associated with dental pathology (P=.4). There was no significant association between fracture length ratio and apical infection (P=1.0). Midline sagittal fractures were significantly associated with sinusitis when compared with all other maxillary fractures (odds ratio [OR] 5.92, 95% confidence interval [CI] 1.67-20.83, P=.006). Loss of the lamina dura was not significantly associated with apical infection (P=.5). There is a maxillary cheek tooth bias in the data set and the subjective grading system. A large proportion of fractured cheek teeth have evidence of apical infection on CT examination and therefore warrant treatment.

Efficiency of a digital electrofulguration system in contaminated root canals in vitro.

Decontamination of the root canal (RC) system is essential for successful endodontic therapy. In this in vitro study, it was evaluated the disinfection potential of an electrofulguration device, the Endox® Endodontic System (EES), in RC infected with Enterococcus faecalis. Sixty-five human lower premolars were instrumented with MTwo® system. The specimens were distributed into six experimental groups (n = 10), according to the irrigation protocol: 2% chlorhexidine gel (CHX); CHX + EES; 5.25% sodium hypochlorite (NaOCl); NaOCl + EES; saline solution (SS); and SS + EES. Five specimens were untreated (control). RC samples were collected before (C1) and after EES treatment (C2), after chemo-mechanical preparation (CMP) (C3), and after final EES treatment (C4). All samples were plated for colony forming units (CFU/mL) onto solid media. The data were analyzed by Wilcoxon and Friedman tests for intragroup comparisons and by Kruskal Wallis test followed by Dunn's test for intergroup comparisons (α = 0.05). Treatment with the EES did not significantly reduce the number of CFU/mL as compared to baseline levels (C1 vs. C2, p> 0.05). After CMP (C3), all groups showed a significantly reduced amount of CFU/mL (p <0.05), with no difference between CHX- and NaOCl-treated samples (p >0.05). Lastly, treatment with the EES following CMP (C4) did not significantly reduce the amount of CFU/mL (C3 vs. C4, p> 0.05). To conclude, the use of the Endox® Endodontic System did not result in considerable bacterial reduction at all operative times, while treatment with NaOCl and CHX was equally efficient for this purpose.